COVID-19, mevcut olan sýnýrlý bilgilere göre, yaþlýlar ve yandaþ hastalýklarý olan her yaþtan insan için ciddi problemler yaratabilecek yeni bir hastalýktýr. Ayrýca, tüm yaþ gruplarý da risk altýndadýr. Saðlýk çalýþanlarý, mesleklerinin doðasý gereði her türlü enfeksiyona yakalanma riskine en çok maruz kalan profesyoneller olmuþtur. Elektif cerrahiler COVID-19 hastalarýna bakým vermek için ertelenmiþtir. Bununla birlikte, travma cerrahisi, akut karýn ve acil endoskopiler gibi bazý müdahaleler geciktirilemez. Saðlýk sisteminin sürdürülebilirliðini korumak için saðlýk çalýþanlarýnýn korunmasý en önemli konulardan birisidir. Öte yandan, acil saðlýk hizmeti gerektiren hastalara da uygun tedavi saðlanmalýdýr. Saðlýk çalýþanlarý, kendilerini ve hastalarýný mümkün olduðunca koruyarak, en uygun tedavi yöntemini seçmelidir. Bu çalýþma, COVID-19 pandemisi sýrasýnda, bir cerrahýn yapmasý gereken müdahale kaçýnýlmaz olduðunda nasýl uygun davranabileceðini özetlemeyi amaçlamaktadýr.

COVID-19 is a new disease, based on currently available limited information, older adults and people of any age who have severe underlying medical conditions may be at higher risk for severe illness from COVID-19. People of all age groups are also at risk. Healthcare providers have always been the professionals most exposed to the risk of contracting to any kind of infection due to the nature of their profession. Elective interventions have been postponed to give care of patients with COVID-19. However, some interventions cannot be delayed, such as trauma surgery, acute abdomen, and emergency endoscopies. To maintain the sustainability of the healthcare system, the protection of healthcare providers should be the top priority. On the other hand, patients, who need emergency healthcare, should also be provided with appropriate treatment. Healthcare professionals should choose a treatment method appropriately in the circumstances to protect themselves and their patients as much as possible. This paper aims to summarize how a surgeon may act appropriately when an intervention is inevitable during the COVID-19 pandemic.

AMAÇ: Avülsiyon yaralanmalarýnýn yönetimi hala zorlayýcý bir konudur ve avülsiye olan deri flepleri nekroza uðrayabilmektedir. Antikoagülan ajanlar olan fondaparinuks ve dabigatran ile tedavi edilen avülsiyon yaralanmalarýnda tekrar yerine sütüre edilen fleplerin saðkalýmýný artýrmasý hedeflenerek avülsiyon yaralanmalarýnýn tedavisinde faydalý olabileceðini düþündük.
GEREÇ VE YÖNTEM: Yirmi dört adet Wistar sýçaný üç gruba ayrýldý: Kontrol grubu (Grup 1), fondaparinuks grubu (Grup 2) ve dabigatran grubu (Grup 3). Tüm sýçanlarýn kuyruðunda bir avülsiyon yaralanma oluþturulduktan 15 dakika sonra, avülsiyonlu dokular geri yerine sütüre edildi. Grup 1, 10 gün boyunca periton içine 1 ml/gün serum fizyolojik aldý. Grup 2, 10 gün boyunca periton içine 0.3 ml/kg/gün fondaparinuks aldý. Grup 3, 10 gün boyunca oral olarak 30 mg/kg/gün dabigatran aldý. Tedavilerin sonunda, morfolojik ve histopatolojik parametreler ve kuyruk doku saðkalýmlarý deðerlendirildi.
BULGULAR: Histopatolojik incelemede fondaparinuks ve dabigatran gruplarýnda kuyruklarýnýn çoðunluðunun saðlam kaldýðý ve enflamasyonun ise hafif düzeyde olduðu gözlendi. Fondaparinuks ve dabigatran gruplarýna göre kontrol grubunda ortalama kuyruk nekroz uzunluðu ve inflamasyonun þiddeti istatistiksel olarak daha yüksek bulundu (p<0.05). Dabigatran ve fondaparinuks gruplarý arasýnda nekrotik alanýn uzunluðu ve diðer histopatolojik parametreler açýsýndan anlamlý bir fark saptanmadý (p>0.05).
TARTIÞMA: Dabigatran ve fondaparinuks, avülsiyon yaralanmasýnda morfolojik ve histopatolojik bulgular ile doku saðkalýmýný artýrmýþtýr. Bununla birlikte, bu çalýþmanýn bulgularý yeni deneysel çalýþmalar ve özellikle klinik çalýþmalar ile desteklenmeli ve geliþtirilmelidir.

BACKGROUND: Management of the skin degloving injuries is still a problematic issue, and the avulsed part of the skin may become necrotic. We hypothesized that the anticoagulant pharmacological agents, fondaparinux and dabigatran may be beneficial in the treatment of degloving injuries by enhancing the viability of the reattached flap.
METHODS: Twenty four Wistar rats were divided into three groups as follows: control group (Group 1), fondaparinux group (Group 2) and dabigatran group (Group 3). A model of a degloving injury on the tail of rats was developed in all groups. After 15 minutes, the avulsed flaps were sutured back. Group 1 received 1ml/day saline intraperitoneally for 10 days. Group 2 received 0.3 ml/kg/day fondaparinux intraperitoneally for 10 days. Group 3 received 30 mg/kg/day dabigatran orally for 10 days. At the end of the treatments, gross morphological and histopathological tail tissue survivals were evaluated.
RESULTS: Histopathological examination of the fondaparinux and dabigatran groups revealed that the tail skin was mostly viable with mild inflammation. The mean necrotic length in tails and severity of inflammation was significantly higher in the control group compared to the fondaparinux and dabigatran groups (p<0.05). No statistically significant differences were noted between the fondaparinux and dabigatran groups in histopathologic evaluations. There was no significant difference in necrosis lengths and the other histopathological parameters between dabigatran and fondaparinux groups.
CONCLUSION: Dabigatran and fondaparinux improved tissue survival in skin degloving injuries concerning gross morphological and histopathological findings. However, the findings of this study should be supported and improved by new experimental and especially clinical studies.

AMAÇ: Önemli bir mortalite ve morbidite sebebi olan iskelet kasýnýn akut iskemi/reperfüzyon (I/R) hasarý oksidatif stres ile iliþkilidir. Etkin bir antioksidatif ve bir tür karotenoid pigment olan likopen meyve ve sebzelerde bulunmaktadýr. Çalýþmamýz sýçan arka uzuv kas modelinde likopenin Ý/R hasarýna karþý koruyucu etkisini incelemektedir.
GEREÇ VE YÖNTEM: Otuz iki adet Wistar-albino türü sýçan kontrol, likopen, Ý/R ve Ý/R+likopen gruplarýna rasgele daðýtýldý. Likopen ve Ý/R+likopen gruplarýndaki sýçanlar deneyden önceki 15 gün boyunca aðýzdan günde, 10 mg/kg miktarýnda likopen aldý. Tüm sýçanlara genel anestezi altýnda böbrek altý seviyesinde abdominal aorta diseksiyonu uygulandý. I/R ve I/R+likopen gruplarýnda aorta, böbrek altý seviyesinde iki saat süre ile klemp kullanýlarak kapatýldý. Ardýndan bu gruplarda iki saat süre ile reperfüzyona olanak saðlandý. Feda edildikten sonra sýçanlarýn arka uzuv kasýndan biyokimyasal ve histopatolojik inceleme için örnekler alýndý.
BULGULAR: I/R+likopen grubunda serum ve doku malondialdehit ve iskemi modifiye albumin düzeyleri I/R grubuna kýyasla anlamlý derecede düþüktü (p<0.001). I/R grubunda serum glutatyon peroksidaz (GSH-Px) düzeylerinin kontrol ve I/R+likopen gruplarýndakine göre anlamlý derecede düþük olduðu belirlendi (p<0.05). I/R grubunda doku GSH-Px düzeyleri likopen grubundakine göre anlamlý derecede düþüktü (p=0.003). Diðer üç gruba oranla I/R grubunda serum süperoksit dismutaz (SOD) düzeylerinin anlamlý derecede düþük olduðu saptandý (p<0.001). I/R grubunda doku SOD seviyeleri kontrol ve likopen gruplarýndakine göre anlamlý derecede düþüktü (p=0.005). Histopatolojik incelemelerde I/R+likopen grubunda I/R hasarýna baðlý enflamatuvar deðiþimlerin belirgin olarak az olduðu görüldü.
TARTIÞMA: Çalýþmamýz sýçan iskelet kasý modelinde likopenin I/R hasarýna karþý hücre koruyucu etkinliðini göstermektedir.

BACKGROUND: Acute ischemia/reperfusion (I/R) injury of skeletal muscle, an important mortality and morbidity cause, is associated with oxidative stress. Lycopene is a carotenoid pigment with potent antioxidant activity and is found in vegetables and fruits. This study aims to investigate the protective effects of lycopene against I/R injury in rat hind limb muscle model.
METHODS: Thirty-two Wistar-albino rats were randomly allocated to control, lycopene, I/R and I/R+lycopene groups. In lycopene and I/R+lycopene groups, the rats received 10 mg/kg/day lycopene orally for 15 days before the experiment. Dissection around abdominal aorta at the infrarenal level was performed in all rats under general anesthesia. The aorta was clamped at the infrarenal level in the I/R and I/R+lycopene groups for two hours. Then, reperfusion was allowed for two hours in these groups. Samples were obtained from the hind limb muscles of rats after sacrifice for biochemical and histopathological analyses.
RESULTS: Serum and tissue malondialdehyde and ischemia-modified albumin levels were significantly lower in the I/R+lycopene group compared to I/R group (p<0.001). Serum glutathione peroxidase (GSH-Px) levels were significantly lower in the I/R group compared to those in control and I/R+lycopene groups (p<0.05). Tissue GSH-Px levels were significantly lower in the I/R group compared to the Lycopene group (p=0.003). Serum superoxide dismutase (SOD) levels were significantly lower in the I/R group compared to three groups (p<0.001). Tissue SOD levels were significantly lower in the I/R group compared to those in control and Lycopene groups (p=0.005). Histopathological assessments revealed that inflammatory changes following I/R injury were significantly reduced in the I/R+lycopene group.
CONCLUSION: The findings obtained in this study show lycopene’s cytoprotective activity against I/R injury in rat skeletal muscle model.

AMAÇ: Periferik sinir yaralanmasýnda cerrahinin zamanlamasý hala tartýþmalýdýr. Periferik sinir hasarýnýn derhal ve gecikmiþ primer (yedi gün sonra) onarýmýnýn sonuçlarý deðerlendirildi.
GEREÇ VE YÖNTEM: Wistar cinsi sýçanlar 4 gruba ayrýldý: Sinir keskin þekilde Grup 1, 2 ve 4’te kesildi. Grup 1’de hemen dikildi ve Grup 2’de yedi gün sonra dikildi ve Grup 4’te dikilmedi. Grup 3’te sol siyatik sinir sadece eksplore edildi. Sekiz hafta sonra, yaralanan sinir bölgesinden doku örnekleri alýndý. Her iki gastrocnemius kaslarý tartýldý. Sinir örnekleri akson dejenerasyonu açýsýndan incelendi. Miyelin vakuolizasyonu, akson düzensizliði ve ödem/enflamasyon parametreleri deðerlendirildi.
BULGULAR: Acil ve gecikmiþ primer onarým gruplarý arasýnda akson dejenerasyonu skoru ve gastrocnemius kasýnýn aðýrlýðý açýsýndan anlamlý fark yoktu. Bununla birlikte, bu parametreler her iki tamir grubunda da kontrol grubundan anlamlý derecede daha iyiydi ve sinir kesisi yapýlmayan gruptan anlamlý derecede daha kötüydü.
TARTIÞMA: Sýçanlarda siyatik sinir transeksiyon modelinde onarýmýn yaklaþýk bir hafta geç yapýlmasý acil onarým ile karþýlaþtýrýldýðýnda, kesilmiþ sinirin uyardýðý kasýn histolojik sonuçlarýný ve aðýrlýðýný etkilememiþtir.

BACKGROUND: The debate continues concerning surgical timing in a peripheral nerve injury. This study aims to evaluate the result of immediate versus delayed primary (after seven days) repair of peripheral nerve injury.
METHODS: In this study, Wistar rats were divided into four groups as follows: The nerve was sharply transected in Group 1, 2 and 4. It was immediately sutured in Group 1 and sutured seven days later in Group 2, and it was not sutured in Group 4. In Group 3, the left sciatic nerve was only explored. Eight weeks later, tissue samples were extracted from the injured nerve area. Both gastrocnemius muscles were weighed. The nerve samples were examined for axon degeneration. Myelin vacuolization, axon irregularity, and edema/inflammation parameters were evaluated.
RESULTS: There were not any significant differences in the score of axon degeneration and the weight of the gastrocnemius muscle between the immediate and delayed primary repair groups. However, these parameters were significantly better in both repair groups than to be in the control group and significantly worse than to be in the sham-operated group.
CONCLUSION: To delay the repair about one week did not affect the histological results and weight of the muscle that was innervated by the sectioned nerve comparing to be in the immediate repair in a sciatic nerve transaction model in rats.

AMAÇ: Çeþitli cerrahi ve organ transpalantasyonu, strangüle herniasyonlar ve neonatal nekrotizan enterokolit gibi klinik durumlarda ortaya çýkan intestinal iskemi reperfüzyon (I/R) hasarý cerrahi yoðun bakým ünitelerindeki ölümlerin en baþlýca sebebini oluþturur. Ýskemi-reperfüzyon (IR) neden olduðu baðýrsak hasarýnda oksidatif stresin rol oynadýðý bildirilmesine raðmen kalýcý bir çözüm bulunamamýþtýr. Bu çalýþmada I/R neden olduðu ince baðýrsak üzerindeki etkilerini moleküler düzeyde inceyerek, adalimumab (ADA) ve antioksidanlarýn olasý koruyucu potansiyelini geleceðe dönük ele aldýk.
GEREÇ VE YÖNTEM: Toplam 24 erkek Sprague-Dawley sýçanlar rasgele olarak kontrol, iskemi/reperfüsion (I/R) ve I/R+ADA uygulama grubu olmak üzere üç gruba ayrýldý.
BULGULAR: I/R grubunda ince baðýrsak dokusunda GSH seviyesinde bir deðiþiklik gözlemlenmemekle beraber MDA seviyesini ve kaspaz-3 pozitif enterositlerin sayýsal yoðunluðunu artýrdýðýný gözledik (sýrasýyla, p=0.00; p=0.00). Bunun yanýnda villus kripta yapýlarýnda dejenerasyona neden olduðunu saptatýk. ADA tedavisinin I/R grubuna kýyasla MDA seviyesini ve kaspaz-3 pozitif enterositlerin sayýsal yoðunluðunu azalttýðýný gözlemledik (sýrasýyla, p=0.00; p=0.011).
TARTIÞMA: Adalimumab, I/R neden olduðu intestinal hasarýn önlenmesinde yararlý olabilir.

BACKGROUND: The present study aims to observe the effects of ischemia-reperfusion (IR) on small intestines at a molecular level and to prospectively assess the potential preventive role of adalimumab (ADA) and antioxidants.
METHODS: A total of 24 male Sprague–Dawley rats were randomly divided into three groups–a control group, an IR group and an IR+ADA group.
RESULTS: Although there was no change in SOD levels in the small bowel tissue of the IR group, we observed increased malondialdehyde (MDA) levels and increased numerical density of caspase-3 and TNF-α positive enterocytes p=0.00 and p=0.00, respectively). We also observed that IR caused the degeneration of villus crypt structures.
CONCLUSION: We found that ADA treatment reduced MDA levels and decreased the numerical density of caspase-3 and TNF-α positive enterocytes compared to the IR group (p=0.00; p=0.011; p=0.00, respectively). We conclude that ADA can be beneficial in preventing intestinal injury that arises from IR.

AMAÇ: Koroziv yanýklarda en sýk etiyolojik neden alkali maddelerdir. Hypericum Perforatum’un deneysel özofagus ve mide alkali koroziv yanýk modelinde etkili olup olmadýðý araþtýrýldý.
GEREÇ VE YÖNTEM: Araþtýrmada 42 adet, 200–300 gram aðýrlýðýnda, Wistar Albino sýçanlar seçildi ve 6 grup oluþturuldu; Grup 1: Kontrol, Grup 2: Yanýk+SF (YSF), Grup 3: Yanýk+Kantaron (YK), Grup 4: Yanýk+Plasebo (YP), Grup 5: Kantaron (K), Grup 6: Plasebo (P). Tedavi sonrasýnda 15. gün diseksiyon uygulanarak alýnan özofagus, mide ve karaciðer doku örneklerinden, histopatolojik ve biyokimyasal belirteçlere (SOD, GPX, MDA, CAT) bakýldý. Uygulanan ilaç formulizasyonunun fibroblastlar üzerine sitotoksitesi invitro koþullarda eriþkin insan dermal fibroblast hücre hattýnda deðerlendirildi (HDFa, Gibco invitro hücre kültürü, C-013-5C).
BULGULAR: Deneklerin aðýrlýk deðerlerinin karþýlaþtýrmasýnda Grup 1, 3, 4 ve 6 da aðýrlýk artýþ, Grup 2’de aðýrlýk kaybý saptandý, Grup 5’te ise anlamlý bir fark saptanmadý. YK grubunda özefagusta submukozal kollojen birikimi, muskularis mukoza hasarý, tunika muskularis hasarý ve kollojen akümülasyonu kontrol grubu ile benzerdi, fakat YSF ve plasebodan daha azdý. Midede mukozal hasar, gastrik bez dilatasyonu, submukozal PMNL infiltrasyonu YK grubunda kontrol grubu ile benzer ve YSF grubundan daha az idi. Kantaronun letal kosantrasyonu 2.58 gr/mL idi.
TARTIÞMA: Kantoron özefagus ve midenin orta derecede alkali koroziv yanýklarýnda subakut periyotta korumada etkilidir. Kantaronun gastrointestinal sistemin koroziv yanýklarýnda kullanýlabileceði akýlda tutulmalýdýr.

BACKGROUND: The most frequent etiologic cause is alkaline substances. We investigated the protective effects of the plant St. John ‘s Wort (Hypericum perforatum).
METHODS: We included 42 Wistar albino rats weighing between 200–300 grams and divided into six groups as Group 1: Control, Group 2: Burn+Saline (BS), Group 3: Burn+St. John’s Wort (BSJW), Group 4: Burn+Plasebo (BP), Group 5: St. John’s Wort (SJW), Group 6: Placebo (P). After 15 days of treatment, esophagus, stomach and liver tissue samples were derived by dissection for histopathologic and biochemical markers. The cytotoxic effects of formulation on fibroblasts is evaluated in vitro on human dermoblast fibroblast line (HDFa, Gibco Invitrogen cell culture, C-013-5C).
RESULTS: The weight of the rats increased in Group 1, 3, 4, 6, decreased in Group 2 and did not change in Group 5. In the BSJW group, submucosal collagen accumulation, muscularis mucosa damage, tunica muscularis damage and collagen accumulation in esophagus were similar to the control group but lesser than BS and placebo group. In the stomach, mucosal damage, gastric gland dilatation, submucosal polymorphonuclear infiltration were similar to the control group and lesser than the BS group. The lethal concentration of SJW was 2.58 gr/mL.
CONCLUSION: SJW substrate is effective in protecting the esophagus and stomach in mild to moderate alcali corrosive burns in the subacute period. We should keep in mind the protective effects of STW substrate in alkaline corrosive burns of the gastrointestinal system.

AMAÇ: Ýntrakorporial sütür ve Hem-o-lok klipsin birbirlerine etkinlik, güvenilirlik ve maliyet açýsýndan üstünlüklerinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Acil servise baþvuran ve akut apandist tanýsý ile ameliyat kararý verilen olgulara laparoskopik apendektomi uygulandý. Apendiks güdüðü Hem-o-lok klips (Grup I) ve intrakorporial sütür 2/0 ipek (Grup II) ile kapatýldý. Gruplar demografik veriler (yaþ cinsiyet, vücut kitle indeksi [VKÝ], ASA), operasyon süresi, maliyet, operasyondan sonra 2.–6.–12.–24.–36. saat ve 7. gün aðrý yönünden karþýlaþtýrýldý.
BULGULAR: Olgularýn yaþ, cinsiyet ve VKÝ gibi demografik verileri gruplar arasý benzerdi (p>0.05). Peroperatif ve ameliyat sonrasý görülen komplikasyonlar açýsýndan gruplar arasý karþýlaþtýrmalarýnda anlamlý fark bulunmadý (p>0.05). Hiçbir olguda ameliyat sonrasý bulantý kusma, ileus ve karýniçi apse görülmedi. Olgularýn ameliyat süreleri, hastanede kalýþ süreleri ve maliyeti açýsýndan gruplar arasýnda anlamlý fark bulunmadý (p>0.05). Olgularýn gruplara göre aðrý skorlarý arasýnda anlamlý fark bulunmadý. Ameliyat tipi aðrý skorlarýný etkilemedi (p>0.05).
TARTIÞMA: Bu çalýþma laparoskopi apendektomi de, apendiks güdüðünün kapatýlmasýnda hem intrakorporial sütür hemde Hem-o-lok klipsin etkin, güvenilir ve benzer maliyetli olduðunu gösterdi. Uygulanacak yöntemin seçiminde cerrahýn deneyimi baz alýnmalýdýr.

BACKGROUND: In this study, we aimed to evaluate the superiority of intracorporeal sutures and Hem-o-lok clips about efficiency, reliability and cost.
METHODS: We performed laparoscopic surgery for acute appendicitis in this study. Appendiceal stump was closed by Hem-o-lok clips (Group I) and intracorporeal knotting (Group II) in a randomized manner. Groups were compared for demographic data (age, sex, body mass index, American Society of Anesthesiologists score) operation time, total cost, 2.6.12.24.hours and 7th day pain score.
RESULTS: Demographic data, such as age, gender and BMI, were similar between groups (p>0.05). There was no significant difference between the groups concerning peroperative and postoperative complications (p>0.05). No postoperative nausea, vomiting, ileus and intraabdominal abscess were observed in patients. There was no significant difference between the groups about duration of operation, length of hospital stay and cost analysis (p>0.05). There was no significant difference in pain scores of groups. The effect of the operation type on pain scores was not statistically significant (p>0.05).
CONCLUSION: This study showed that both intracorporeal knotting and Hem-o-loc clips were effective, reliable and similar cost-effective in laparoscopic appendectomy. The decision should be based on the surgeon’s experience.

AMAÇ: Bu çalýþma, akut apandisit tanýsýnda tiyol/disülfit homeostaz parametrelerinin rolünü göstermeyi ve bu parametrelerin modifiye Alvarado ve RIPASA skorlama sistemleriyle birlikte kullanýlmasýnýn yararlý olup olmadýðýný belirlemeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Bu çalýþma, acil servise 01.07.2017 ve 31.12.2017 tarihleri arasýnda sað alt kadran aðrýsý þikayeti ile baþvuran ve çalýþmanýn dahil edilme kriterlerini karþýlayan 265 hastada ileriye yönelik olarak gerçekleþtirildi. Oksidatif stres belirteçleri iki grupta deðerlendirildi. Bu parametrelerle modifiye Alvarado ve The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) skorlama sistemleri arasýndaki iliþki analiz edildi.
BULGULAR: Apandisit grubunda ortalama disülfit, disülfit/native tiyol ve disülfit/total tiyol seviyeleri anlamlý olarak yüksek bulundu (p<0.001). Native tiyol, total tiyol ve native tiyol/total tiyol ortalamalarý ayný grupta anlamlý olarak düþüktü (sýrasýyla, p<0.001, 0.001 ve 0.007). Ortalama disülfid, disülfid/native tiyol ve disülfid/total tiyol seviyelerinin RIPASA sonuçlarýna göre yüksek riskli grupta anlamlý olarak yüksek olduðu saptanmýþtýr (sýrasýyla, p=0.016, 0.003 ve 0.001).
TARTIÞMA: Tiyol/disülfit homeostaz parametreleri, akut apandisit tanýsýnda modifiye Alvarado ve RIPASA skorlama sistemleriyle birlikte kullanýlabilir.

BACKGROUND: This study aims to investigate the role of thiol/disulfide homeostasis parameters in the diagnosis of acute appendicitis and to determine whether it is beneficial to use these parameters in combination with the modified Alvarado and RIPASA scoring systems.
METHODS: This study was prospectively carried out on 265 patients who presented to the emergency department with the complaint of right lower quadrant pain between 01.07.2017 and 31.12.2017, and met the inclusion criteria of this study. Oxidative stress markers were evaluated on two groups. The relationship between these parameters and the modified Alvarado and RIPASA scoring systems was analyzed.
RESULTS: The mean levels of disulfide, disulfide/native thiol and disulfide/total thiol were found to be significantly higher in the appendicitis group (p<0.001). The mean levels of native thiol, total thiol and native thiol/total thiol were significantly lower in the same group (p<0.001, 0.001 and 0.007, respectively). The mean levels of disulfide, disulfide/native thiol and disulfide/total thiol were recorded to be significantly higher in the high-risk group according to the results of RIPASA (p=0.016, 0.003 and 0.001, respectively).
CONCLUSION: Thiol/disulfide homeostasis parameters can be used with the modified Alvarado and RIPASA scoring systems in the diagnosis of acute appendicitis.

AMAÇ: Koledokolitiyazis nedeni ile acil endoskopik retrograd kolanjiyopankreatografi (ERCP) yapýlan hastalarda laparoskopik kolesistektomi (LK) için optimal zamanlama konusunda fikir birliði yoktur. Her ne kadar bazý veriler erken dönemde cerrahinin veya tek aþamalý LK ile birlikte yapýlan laparoskopik safra kanalý eksplorasyonunun daha olumlu sonuçlara sahip olduðunu düþündürse de deneyim eksikliði, gerekli malzeme yokluðu veya klinik kýsýtlýlýklar nedeniyle geç dönem LK çoðunlukla ERCP sonrasý sebat eden safra taþý olan hastalarýn standart tedavisi olarak tercih edilmektedir. Bu çalýþmanýn amacý, ERCP ve LK arasýndaki farklý zaman aralýklarýnýn perioperatif sonuçlar üzerindeki etkilerini deðerlendirmektir.
GEREÇ VE YÖNTEM: ERCP ile ana safra kanalý taþlarý tedavi edilen ve daha sonra LK uygulanan ardýþýk hastalarýn ameliyat öncesi ve sonrasý verileri geriye dönük olarak incelendi. Farklý zaman aralýklarýnýn sonuçlar üzerindeki etkisini deðerlendirmek için hastalar son yapýlan ERCP’den LK’ye kadar geçen süreye göre üç gruba ayrýldý: 2 hafta içinde (Grup 1), 2–6 hafta arasýnda (Grup 2) ve 6 haftadan sonra (Grup 3).
BULGULAR: Bu çalýþmada ortalama yaþý 52.8 olan toplam 67 hasta analiz edildi. Olgularýn kapalý ameliyattan açýða geçme oraný Grup 1’de %20, Grup 2’de %25 ve Grup 3’te %13.6 idi (p=0.646). Bu oran erkek hastalarda %25 ve kadýnlarda ise %14.2 olarak hesaplandý. Gruplar arasýnda cinsiyet, yandaþ hastalýk, laboratuvar ve safra kesesi özellikleri, ameliyat süresi ve hastanede kalýþ süresi açýsýndan anlamlý fark bulunmadý. Perioperatif komplikasyon oraný %17.9 bulundu; ancak gruplar arasýnda komplikasyon oraný açýsýndan anlamlý fark saptanmadý (p=0.289).
TARTIÞMA: Bu çalýþmadan elde edilen sonuçlar, ERCP sonrasý yapýlan LK’nin komplike olmayan standart kolelitiazis için yapýlan LK’den daha kompleks ve daha yüksek açýða geçiþ oranýna sahip olduðunu desteklemektedir. Kolelitiazise eþlik eden ana safra kanalý taþlarý olan hastalarda ERCP sonrasýnda farklý zaman aralýðýnda uygulanan LK’nin perioperatif sonuçlar üzerinde anlamlý bir etkisi görülmemesine raðmen, LK’nin açýk cerrahiye geçmesi açýsýndan ERCP’den sonraki 2–6 hafta kritik bir dönemdir. Ayrýca geç dönemde yapýlan LK’de ciddi komplikasyonlarýn ortaya çýkabileceði ve tekrarlayan biliyer ataklarýn olabileceði göz önünde bulundurulduðunda ERCP sonrasý LK’nin erken dönemlerde yapýlmasý önerilir.

BACKGROUND: There is no consensus on the optimal timing for laparoscopic cholecystectomy (LC) after emergent endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis. Although certain data suggest that an early interval or single-stage treatment by LC, together with laparoscopic bile duct exploration, has more favorable outcomes, delayed LC is most often preferred as the standard treatment of patients with gallstones and choledocholithiasis following ERCP due to lack of experience, necessary instrumentation, or organizational restrictions. This study aims to compare the effects of different time intervals between ERCP and LC on perioperative outcomes.
METHODS: In this paper, preoperative and postoperative data from consecutive patients who were treated for common bile duct stones with emergent ERCP and then underwent LC were reviewed retrospectively. To evaluate the impacts of different time intervals on outcomes, patients were classified into three groups according to the duration from the last ERCP to LC: within two weeks (Group 1), between 2–6 weeks (Group 2), and over six weeks (Group 3).
RESULTS: This study involved an analysis of 67 patients with a mean age of 52.8 years. Overall conversion rate was 20.0% in Group 1, 25.0% in Group 2, and 13.6% in Group 3 (p=0.646). The rate of conversion to open surgery was 25.0% in male patients and 14.2% in females. In addition, no significant difference was found between the groups concerning gender, comorbidities, laboratory and gallbladder features, operation time, and length of the hospital stay. The perioperative complication rate was found to be 17.9%; however, there was no significant difference between the three groups.
CONCLUSION: Our results support that LC after ERCP is more complex and has higher conversion rates than LC for uncomplicated cholelithiasis. Although no significant effect of different time intervals between ERCP and LC on perioperative outcomes was demonstrated in patients with common bile duct stones concomitant with cholelithiasis, the 2–6 weeks after ERCP is a critical period for conversion to open surgery. It is recommended that LC after ERCP should be performed in the early period, considering that serious complications may occur in the late period and recurrent biliary attacks may occur.

AMAÇ: Keneler insan ve hayvanlarýn önemli ektoparazitleridir. Keneler insanlara hastalýða neden olan patojenler bulaþtýrabilir. Kene temasý Kýrým-Kongo Kanamalý Ateþi dahil olmak üzere çeþitli viral ve bakteriyel enfeksiyonlara yol açabilir. Kenelerin uygun yöntemlerle zamanýnda çýkarýlmasý hastalýk bulaþýmýnýn önlenmesi için önemlidir. Kene çýkartým teknikleri hastalýðýn oluþmasýnda etkili olabileceði için incelemeye deðer bulunmuþtur. Çalýþmamýzda bu tekniklerden ikisi olan kementle çýkarma ve tweezers yöntemlerini deðerlendirmek, iki yöntemi karþýlaþtýrmak ve bu yöntemlerle yapýlan hatalarý incelemek amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Bu çalýþma ileriye yönelik bir kesitsel çalýþma olarak tasarlandý, acil servise kene temasý ile baþvuran hastalarda saðlýk profesyonelleri veya hastalarýn kendileri tarafýndan çýkarýlan keneyle ilgili olgular yer aldý. Keneler büyüme periyodlarýna göre larva, nimf ve yetiþkin olarak kaydedildi. Kene çýkartým türleri ve çýkarmada yapýlan hatalar kaydedildi.
BULGULAR: Kenelerin çoðunluðu (%77.4) saðlýk profesyonelleri tarafýndan, daha düþük bir oranda ise hastalarýn kendileri tarafýndan el ile çýkarýlmýþtý (%22.6). Yetmiþ iki hastada (%77.4) herhangi bir hata bulunmadý, kene bir bütün olarak çýkarýlmýþtý, 15 hastada (%16.1) parçalanmýþ olarak çýkarýlýrken, 6 (%6.45) hastada ise kene bir bütün olarak çýkarýlmýþ ancak sütürler yanlýþ baðlanmýþtý. Teknik hatalara baðlý kene parçalanmasý en çok kiþilerin kendi çýkardýðý kenelerde görüldü.
TARTIÞMA: Bu çalýþmanýn sonuçlarý uygun ve doðru bir þekilde uygulandýðýnda hem kement atma hem de tweezers tekniklerinin kene çýkarmada etkili olduðunu göstermiþtir. Bu konuda halkýn farkýndalýðýný artýrma ve eðitim programlarý artýrýlmalýdýr.

BACKGROUND: Tick is among the important ectoparasites of humans and animals. Ticks may transmit disease-causing pathogens to humans. Tick contact may be resulted in several viral and bacterial infections, including Crimean-Congo Hemorrhagic Fever. Timely removal of ticks with appropriate methods is important in prevention of disease transmission. There are many methods reported for tick detachment. In this study, we aimed to evaluate two of them, suture lassoing and freezing and to compare both methods and to examine technical mistakes with these techniques.
METHODS: This study was designed as a prospective cross-sectional study, and included the ticks detached by healthcare professionals or directly by patients who presented to the emergency department due to tick contact. The ticks were recorded as larvae, nymphs, and adults according to their growth period. Ticks detachment types with surgical sutures and removal mistakes were recorded.
RESULTS: The majority (77.4%) of the ticks were removed by healthcare professionals and a lower rate by patients themselves with hand (22.6%). No technical mistake was found in 72 (77.4%) patients, and the tick was detached as a whole, while detached broken in 15 (16.1%) patients, and the tick was detached as a whole, but the sutures were attached wrong in six (6.5%) patients. Tick broken off due to technical mistakes was most commonly seen in the ticks removed by the individuals themselves.
CONCLUSION: The results of this study suggest that when appropriately and correctly used, both suture lassoing and tweezers are effective in tick removal. Public awareness-raising and training programs should be increased on this issue.

AMAÇ: Ýnsanlarda yaþam beklentisi arttýkça, yaþlý insanlara uygulanan cerrahi prosedürler cerrahi ve ameliyat sonrasý bakýmdaki geliþmelere paralel olarak artmaktadýr. Geriatrik hastalarýn morbidite-mortalitesini araþtýran önemli sayýda çalýþma acil ameliyat geçirenlerle ilgilidir. Bu çalýþmanýn amacý yaþlýlarda acil cerrahi sonrasý mortalite ve morbiditeyi etkileyen faktörleri araþtýrmaktýr.
GEREÇ VE YÖNTEM: Ocak–Aralýk 2018 tarihleri arasýnda Saðlýk Bilimleri Üniversitesi Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi’nde acil þartlarda ameliyat edilen 65 yaþ ve üstü 200 hastanýn verileri geriye dönük olarak deðerlendirildi.
BULGULAR: Hastalarýn demografik özellikleri yaþ, cinsiyet, ASA fiziksel durumlarý, komorbiditeleri, fonksiyonel olarak baðýmlý olup olmadýklarý, ameliyat tipleri, anestezi tekniði, ameliyat süresi, intraoperatif kan transfüzyonu, hematokrit düzeyindeki deðiþiklikler (perioperatif dönemde) cerrahi sonrasý sonuç (yoðun bakým ya da servise transfer) kaydedildi. Kýsa vadeli ölümlerin risk tahmini, Charlson Comorbidity Ýndeks (CCÝ) ve APACHE II puanlama sistemleri kullanýlarak tahmin edildi.
TARTIÞMA: Hastalarýn yaþ ortalamasý 74.8±6.7 idi ve kadýn sayýsý (n=134, %67) erkeklerden daha yüksekti. Yüksek ASA fiziksel durum skorlarý, baðýmlý yaþam koþullarý, uzun ameliyat süresi, genel anestezi, intraoperatif kan transfüzyonu, düþük Htc deðerleri (<%25), yüksek APACHE II skorlarý ve 10 yýllýk sað kalým skorlarýnýn CCÝ’ye göre daha düþük olmasý yoðun bakým ünitesine kabulü etkileyen faktörlerdir.

BACKGROUND: As life expectancy increases in humans, surgical procedures applied to the elderly people are also increasing in parallel with the developments in surgery and postoperative care. A significant number of studies investigating the morbidity-mortality of geriatric patients are related to patients who are undergoing emergency operations. The present study aims to investigate the factors affecting mortality and morbidity after emergency surgery in elderly people.
METHODS: The data of 200 patients aged 65 years and over who were operated under emergency conditions in the University of Health Sciences Kartal Dr. Lütfi Kýrdar Training and Research Hospital between January and December 2018 were evaluated retrospectively.
RESULTS: Patient’s demographic information, including age, gender, ASA physical status, comorbidities, functional dependency or non-dependency of patients, types of operation, anesthesia technique, duration of operation, intraoperative blood transfusion, the changes of hematocrit levels (during the perioperative period), the outcome after surgery (intensive care admission or ward transfer), were recorded. The risk prediction of short-term mortality has been estimated using CCI and APACHE II scoring systems.
CONCLUSION: The mean age of the patients was 74.8±6.7 and the number of females (n=134, 67%) outweighed the males. Higher ASA physical status scores, dependent living conditions, long operation time, general anesthesia, intraoperative blood transfusion, low Htc values (<25%), high APACHE II scores and lower scores of 10-years survival by CCI were the factors that affected the acceptance into ICU.

AMAÇ: Dekompresif kraniektomi (DC), travmatik beyin hasarý (TBH) sonrasý intrakraniyal hipertansiyon tedavisinde kullanýlan etkin bir yöntemdir. Transkraniyal Doppler ultrasonografi (TCD) ölçümlerinin dekompresif cerrahi endikasyonundaki etkisini göstermektir.
GEREÇ VE YÖNTEM: Çalýþmaya Glasgow Koma Skoru (GCS) <9 olan 16 TBH hastasý alýndý. Ýntrakraniyal basýnç (ICP) izleme ve TCD ölçümleri sürekli olarak kaydedildi. DC, ICP ve TCD kayýtlarýna göre yapýldý. Glasgow Sonuç Ölçeði (GOS) skorlarý 3 ay sonra deðerlendirildi.
BULGULAR: Hastalarýn yaþ ortalamasý 31.18±17.51, GCS 3 ile 14 arasýnda deðiþmekte olup, ortalama 9.62±3.95 idi. Ortalama GOS 3.12±1.85 idi. Ýki hastaya (%12.5) kraniektomi, 14 hastaya (%87.5) kraniektomi ve lobektomi birlikte yapýldý. ICP’deki düþüþ (22.12±10.41, 22.62±7.35, 15.50±6.64) ve pulsatilite indeksi (PI) (1.96±1.10, 1.64±0.75, 1.91±2.48) 3–5 ve 1–5 günleri arasýnda belirgin olarak anlamlýydý. Beþ güne kadar olan PI ve Vmax deðerleri arasýnda anlamlý bir fark bulunmamýþtýr.
TARTIÞMA: TCD, gerçek zamanlý bir monitör olarak, TBH hastalarýnýn tedavisinde cerrahi yaklaþýmýn erken kararýna yardýmcý olabilir.

BACKGROUND: Decompressive craniectomy (DC) is performed in the management of intracranial hyper-tension after traumatic brain injury (TBI). This study aims to investigate the effects of transcranial Dop-pler ultrasonography (TCD) measurements on the indication of decompressive surgery.
METHODS: Sixteen TBI patients with a Glasgow Coma Score (GCS) <9 were included in this study. Intra-cranial pressure (ICP) monitoring and transcranial Doppler ultrasonography (TCD) measurements were recorded continuously. DC was performed according to the records of ICP and TCD. Glasgow Outcome Scale (GOS) scores were evaluated after three months.
RESULTS: Mean age of the patients was 31.18±17.51; GCS ranged between three and 14 with a mean of 9.62±3.95. Mean GOS was 3.12±1.85. Craniectomy was performed in two patients (12.5%) and cra-niectomy and lobectomy together were performed in 14 (87.5%) of them. The decline in ICP (22.12±10.41, 22.62±7.35, 15.50±6.64) and pulsatility index (PI) (1.96±1.10, 1.64±0.75, 1.91±2.48) were strongly significant between days 3–5, and 1–5. The range of PI and Vmax values through five days did not present any significance.
CONCLUSION: TCD, as a real-time monitor, may help for an early decision of surgical approach in the management of TBI patients.

AMAÇ: Distal tibial epifiz kýrýklarý, epifiz büyüme plaðýna zarar verir. Distal tibial epifiz yaralanmasýndan sonra epifiz büyümesi durmasý (EBD), osteoartrit, refleks sempatik distrofi ve ayak bileði eklemi sertliði de görülebilir. Bu çalýþmanýn amacý, cerrahi olarak tedavi edilen distal tibial epifiz kýrýklarýnda travma mekanizmasý, kýrýk paterni ve fiksasyon tekniðinin klinik sonuçlar ve EBD üzerindeki etkisini deðerlendirmektir.
GEREÇ VE YÖNTEM: 2011–2017 yýllarý arasýnda distal tibial epifiz kýrýðý nedeniyle opere edilen 27 hasta geriye dönük olarak deðerlendirildi. Travma mekanizmasý, fiksasyon tekniði, ameliyat öncesi süre, kýrýk tipinin klinik sonuçlar ve EBD üzerine etkileri incelendi. Klinik sonuçlar AOFAS (Amerikan Ortopedik Ayak ve Ayak Bileði Skoru) ve MOXFQ (Manchester-Oxford Ayak Anketi) skorlarý ile deðerlendirildi.
BULGULAR: Çalýþmaya alýnan 27 hastanýn 17’si erkek, 10’u kadýndý. Hastalarýn yaþ ortalamasý 11.9 idi (daðýlým 5–17 yaþ). Epifizyal hasarýn en önemli komplikasyonu sekiz hastada büyüme duraklamasýydý. Travma mekanizmasý, fiksasyon teknikleri ve kýrýk paternine göre klinik skorlar ve komplikasyonlar açýsýndan istatistiksel olarak anlamlý bir fark gözlenmedi (p>0.05).
TARTIÞMA: Travma mekanizmasý, kýrýk paterni ve fiksasyon materyali ne olursa olsun, distal tibial epifiz kýrýklarýnda komplikasyonlarý azaltmak ve EBD’yi önlemek için anatomik bir redüksiyon elde edilmelidir.

BACKGROUND: Distal tibial epiphyseal fractures damage to epiphyseal growth plate. Epiphyseal growth arrest (EGA), reflex sympathetic dystrophy and ankle joint stiffness may also occur after distal tibial epiphyseal injury. This study aims to evaluate the role of trauma mechanism, fracture pattern and fixation technique on clinical outcomes and EGA in the surgically treated distal tibial epiphyseal fractures.
METHODS: Twenty seven patients who underwent surgery for distal tibial epiphyseal fracture between the 2011 and 2017 were evaluated retrospectively. The effects of trauma mechanism, fixation technique, preoperative duration, fracture patterns on the clinical results and EGA were examined. AOFAS (The American Orthopedic Foot and Ankle Score) and MOXFQ (The Manchester-Oxford Foot Questionaire) were used for clinical evaluation.
RESULTS: Twenty seven patients (17 male and 10 female) were included in this study. The most important complication of epiphyseal injury was the growth pause in eight patients. No statistically significant difference was observed concerning clinical scores and complications according to trauma mechanism, fixation techniques and fracture patterns (p>0.05).
CONCLUSION: Regardless of the trauma mechanism, fracture pattern and the fixation material, an anatomical reduction should be obtained in distal tibial epiphyseal fractures to reduce complications and prevent the EGA.

AMAÇ: Bu çalýþmanýn amacý atlanabilen anstabil servikal yaralanmalarýn belirlenmesinde bilgisayarlý tomografinin (BT) rolünü araþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu çalýþmada acil servise Haziran 2014 ile Haziran 2018 arasýnda künt servikal travma tanýsý ile baþvuran olgular yer almaktadýr. Tüm olgular ilk önce yapýlan bir BT incelemesini takiben servikal manyetik rezonans görüntülemesine (MRG) tabi tutulmuþlardýr. Tüm görüntüleme sonuçlarý gözden geçirilmiþ ve kararlar acil týp uzmaný, nöroradyolojist ve beyin cerrahýndan oluþan bir ekip tarafýndan fikir birliði ile alýnmýþtýr. Diðer deðiþkenler arasýnda yaþ, cinsiyet, Glasgow koma skalasý, ek morbidite, çoklu travma, nörolojik defisitler, intrakraniyal hemoraji, ekstremite kýrýklarý ve yaralanmanýn mekanizmasý yer almaktadýr.
BULGULAR: Çalýþmaya alýnan 195 hastanýn bilgileri analiz edildiðinde; hastalarýn ortalama yaþý (±standart sapma) 47.34±21.90 yýl olup 140’ý erkek (%71.8) 18’i (%9.2) 18 yaþýn altýnda idi. En sýk görülen yaralanma mekanizmasý yüksekten düþme idi (n=100; %51.3). Altýn standart olarak MRG kullanýlmýþ olup, anstabil servikal travma tanýsýnda BT’nin duyarlýlýðý %77.7 (%95 GA [67.1–86.1]) iken, özgüllüðü %100.0 (%95 GA [59.0–100.0]) saptanmýþtýr.
TARTIÞMA: Her ne kadar BT anstabil servikal yaralanmalarýn tanýsýnda rölatif olarak iyi olsa da duyarlýlýðý yeterli deðildir. Bundan dolayý anstabil yaralanmasý olan olgularda MRG çekilmesi daha uygundur.

BACKGROUND: This study aimed to investigate the role of computed tomography (CT) in identifying missed unstable blunt cervical injuries.
METHODS: Patients admitted to the emergency department between June 2014 and June 2018 with a diagnosis of blunt cervical trauma were included in this study. All participants underwent cervical magnetic resonance imaging (MRI) after an initial cervical CT investigation. All imaging results were reviewed, and decisions were taken by the consensus of a team consisting of an emergency medicine specialist, a neuroradiologist, and a neurosurgeon. Other variables included age, sex, the Glasgow Coma Scale, medical comorbidities, multi-trauma, neurological deficits, accompanying intracranial hemorrhage, extremity fractures, and the mechanism of the injury.
RESULTS: Data for 195 patients were analyzed. The mean (±standard deviation) age of the participants was 47.34±21.90 years, and 140 (71.8%) were males. Eighteen patients (9.2%) were below age <18. The most frequent mechanism of injury was fall from height (n=100; 51.3%). Using MRI as the gold standard, the sensitivity of CT in diagnosing unstable cervical injury was 77.7% (95% CI [67.1–86.1]), while its specificity was 100.0% (95% CI [59.0–100.0]).
CONCLUSION: Although computed tomography is relatively good in diagnosing unstable cervical injuries, its sensitivity in detecting positive cases is not as successful. Thus, the use of MRI in patients with an unstable injury seems to be warranted.

AMAÇ: Sunulan çalýþmada 65 yaþ üstündeki kalça kýrýðý nedeni ile ameliyat edilen hastalarda implant çeþidi ve cerrahi zamanlamanýn mortaliteye etkisinin deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Altmýþ beþ yaþ üstü 301 hasta incelendi. Hastalar Grup 1 çimentolu hemiartroplasti, Grup 2 çimentosuz hemiartroplasti ve Grup 3 femur proksimal çivi yapýlanlar olarak ayrýldý. Ameliyat zamaný, kýrýk ve demogrofik bilgileri geriye dönük kaydedildi.
BULGULAR: Bilgilerine ulaþýlamayan 59 hasta çýkarýldýktan sonra çalýþmaya 242 hasta dahil edildi. Hastalarýn ortalama yaþý 80.5 (65–100) idi. Tedavi yöntemine göre hasta gruplarýna bakýldýðýnda; Grup 1 (n=146) %60.3, Grup 2 (n=54) %22.3, Grup 3 (n=42) %17.4. Ýlk 48 saate opere edilenlerle, sonrasýnda opere edilenler arasýnda anlamlý bir fark bulunmadý (p=0.834). Tedavide implant seçiminin survey üzerine etkisi vardý (p=0.016). Çimentolu hemiartroplasti yapýlan hastalarýn surveyinin çimentosuz hemiartroplasti ve proksimal femoral çivi (PFN) yapýlanlara göre daha uzun olduðu görüldü.
TARTIÞMA: Her üç grupta da ilk 48 saatte ameliyata alýnmamanýn mortalite üzerinde anlamlý etkisinin olmadýðý görüldü. Bunun yanýnda yaþ ve cinsiyet mortalite üzerine etkilidir. Ayrýca implant seçimide mortaliteyi etkilemektedir.

BACKGROUND: This study aimed to evaluate the effects on mortality of implant selection used and time to surgery in patients aged over 65 years operated for hip fractures.
METHODS: A total of 301 patients aged over 65 years were investigated in this study. Patients were divided into three groups as follows: Group 1 cemented hemiarthroplasty (CH), Group 2 cementless hemiarthroplasty (CLH), and Group 3 proximal femoral nail (PFN). Time of surgery, fracture and demographic information were retrospectively recorded.
RESULTS: After removing 59 patients with missing information, this study included 242 patients. Mean age of patients was 80.5 years. When patient groups were examined according to treatment method, Group 1 (n=146) comprised 60.3%, Group 2 (n=54) comprised 22.3% and Group 3 (n=42) comprised 17.4% of the study group. There was no significant difference in survival between the patients operated in the first 48 hours and the patients operated later (p=0.834). There was an effect on the survival of treatment implant selection (p=0.016). Patients with CH were observed to survive longer than patients with CLH and PFN.
CONCLUSION: Operation in the first 48 hours was not observed to affect mortality. Additionally, while sex and age were found to be effective on mortality, implant selection was also concluded to affect mortality.

AMAÇ: Asetabulum kýrýðý nedeniyle Modifiye Stoppa yaklaþýmý ile ameliyat edilen hastalardaki intraoperatif kanama miktarýna, anestezi tekniðinin etkisini deðerlendirmektir.
GEREÇ VE YÖNTEM: Ocak 2014 ve Temmuz 2018 tarihleri arasýnda asetabulum kýrýðý nedeniyle Modifiye Stoppa yaklaþýmý ile ameliyat edilen 63 hasta geriye dönük olarak deðerlendirildi. Ýki taraflý asetabulum kýrýðý (n=6), antiagregan tedavisi (n=3), anestezi kayýtlarýnda eksiklik (n=3), hemodinamik instabilite nedeniyle acil pelvik cerrahi geçirmiþ (n=5), dalak yýrtýðý (n=2) ve karaciðer yýrtýðý (n=1) olan, toplam 20 hasta çalýþmadan dýþlandý. Hastalar genel anestezi yapýlanlar (GA) (n=22) ve kombine epidural-genel anestezi yapýlanlar (CEGA) (n=21) olmak üzere iki gruba ayrýldý. Ýntraoperatif kanama miktarý ve intraoperatif ve/veya ameliyat sonrasý kan transfüzyon ihtiyacý, deðerlendirilen ana ölçüm parametreleriydi.
BULGULAR: Gruplar arasýnda yaþ, cinsiyet, kýrýk tipi, yaralanma mekanizmasý, yaralanma ile cerrahi arasýndaki süre, yaralanma þiddet skoru, eþlik eden yaralanmalar ve komorbiditeler açýsýndan istatistiksel anlamlý fark yoktu (p>0.05). Ortalama intraoperatif kanama miktarý GA grubunda 717.27 ml (300–1.600 ml) ve CEGA grubunda 473.81 ml (150–1.020 ml) bulundu (p<0.001). Ýzole asetabulum kýýrðý olan olgularda ise, intraoperatif kan transfüzyon ortalamasý, GA grubundaki 14 hastada 2.43 ünite (1–5 ünite) ve CEGA grubundaki 15 hastada 1.27 ünite (1–4 ünite) bulundu (p<0.001).
TARTIÞMA: CEGA yapýlan hastalarda, GA yapýlan hastalara göre daha az intraoperatif kanama görüldü. Bu, uzun öðrenme eðrisi ve yüksek kanama riski olan asetabulum cerrahi için önemli bir avantajdýr.

BACKGROUND: This study aims to evaluate the effects of the anesthesia technique on the intraoperative blood loss in acetabular fracture patients undergoing the Modified Stoppa approach.
METHODS: We retrospectively identified 63 patients who underwent a Modified Stoppa approach for acetabular fracture from January 2014 to July 2018. A total of 20 patients were excluded from this study for the following reasons: bilateral acetabular fractures (n=6), undergoing antiaggregant treatment (n=3), incomplete anesthesia records (n=3), emergency pelvic surgery due to hemodynamic instability (n=5), splenic rupture (n=2), and liver laceration (n=1). The patients were divided into two groups as follows: patients undergoing general anesthesia (GA) (n=22) and patients undergoing combined epidural-general anesthesia (CEGA) (n=21). The main outcome measurements studied were the intraoperative blood loss and the need for intraoperative and/or postoperative blood transfusions.
RESULTS: No statistically significant differences were found between the groups concerning the age, gender, type of fracture, mechanism of injury, time from injury to surgery, Injury Severity Score, associated injuries, and comorbidities (p>0.05). The mean intraoperative blood losses were 717.27 ml (300–1.600 ml) in the GA group and 473.81 ml (150–1.020 ml) in the CEGA group (p<0.001). In the cases with only an isolated acetabular fracture, the intraoperative blood transfusion means were 2.43 units (1–5 units) in 14 patients in the GA group and 1.27 units (1–4 units) in 15 patients in the CEGA group (p<0.001).
CONCLUSION: Less intraoperative bleeding was seen in those patients undergoing CEGA when compared to those undergoing GA. This is a significant advantage for acetabular surgery, which has a long learning curve and a high risk of bleeding.

AMAÇ: Modifiye El Yaralanmasý Ciddiyet Skoru (MEYCS) ile deðerlendirilen el, el bileði ve ön kol yaralanmalarýnýn baþlangýçtaki anatomik þiddeti ile yaralanma sonrasý özürlülük oranlarý ve iþe geri dönüþ zamaný arasýndaki iliþkiyi araþtýrmaktýr.
GEREÇ VE YÖNTEM: Çalýþmaya akut el, el bileði ve önkol yaralanmasý nedeniyle ameliyat edilen 94 hasta alýndý. Yaralanmanýn þiddeti MEYCS ile belirlendi. Yaralanmadan 6 ay sonra hastalarýn özürlülük oranlarý ‘Özürlülük Ölçütü, Sýnýflandýrmasý ve Özürlülere Verilecek Saðlýk Kurulu Raporlarý Hakkýnda Yönetmelik’e göre hesaplandý. Ýþe geri dönüþ süresi, yaralanma ile hastanýn iþe geri dönüþü arasýndaki sürenin (gün) uzunluðu olarak tanýmlandý. MEYCS ile özürlülük oranlarý ve iþe geri dönüþ zamaný arasýndaki iliþki Sperman korelasyon analizi ile araþtýrýldý.
BULGULAR: Ortalama MEYCS; 125.23 (5–880), üst ekstremite özürlülük oraný (ÜEÖO);17.64±22.6 (daðýlým: 0–94) ve total vücut özürlülük oraný (TVÖO); 10.57±13.45 (daðýlým: 0–56) olarak bulundu. Çalýþmaya dahil edilen 87 (92.6%) hasta eski iþine geri döndü. Ortalama iþe geri dönüþ zamaný; 138.69 (daðýlým: 35–365 gün) olarak bulundu. MEYCS ile ÜEÖO ve TVÖO arasýnda, iþe geri dönüþ zamaný ile ÜEÖO ve TVÖO arasýnda istatiksel olarak anlamlý bir korelasyon bulundu (p<0.001).
TARTIÞMA: Sonuç olarak, yaralanmanýn baþlangýçtaki þiddeti arttýkça hastalarýn özürlülük oranlarý ve iþe geri dönüþ zamanlarý artmaktadýr. Hastalarýn ilk deðerlendirmesinde yaralanmanýn ciddiyetini saptayarak prognoz hakkýnda ön görüye sahip olmak hastalarýn gelecekteki kalýcý sakatlýk seviyesini tahmin etmede ve böylelikle hasta beklentilerinin makul düzeyde tutulmasý saðlanarak psikososyal destek açýsýndan önemli olabilir.

BACKGROUND: This study aimed to examine the relationships between the initial anatomic severity of hand, wrist and forearm injuries, as evaluated by the Modified Hand Injury Severity Score (MHISS), and each of the following parameters: disability rating and time to return to work.
METHODS: In this study, 94 patients who underwent operations due to acute hand, wrist and forearm injuries were included. MHISS was used to assess the severity of the injury. Disability rates of the patients were calculated six months after injury in accordance with the ‘Regulation on Disability Criteria, Classification and Health Board Reports to be Given to Disabled People’. The time to return to work was defined as the length of time (in days) between the injury and the patient’s return to work. Spearman rank correlation analysis was performed to analyse correlations between the MHISS and each of the following: disability rates and time to return to work.
RESULTS: The mean overall MHISS was 125.23 (5–880). The mean overall upper extremity disability ratio (UEDR) was 17.64±22.6 (range: 0–94), and the mean overall total body disability ratio (TBDR) was 10.57±13.45 (range: 0–56). Among the study population, 87 (92.6%) patients were able to return to their jobs. The mean overall time to return to work was 138.69 (range: 35–365 days). A statistically significant correlation was found between MHISS and UEDR, TBDR and time to return to work and UEDR, TBDR (p<0.001).
CONCLUSION: As a result, as the initial injury severity increased, greater disability remained and the time to return to work increased. Predicting prognosis by determining the injury severity in the initial evaluation of patients may be important in predicting a patient’s future permanent disability level, which can contribute to maintaining patient expectations at a reasonable level, thereby aiding in psychosocial support.

AMAÇ: Çocukluk çaðýnda acil servise baþvurularýn yaygýn nedenlerinden biri çoðunluðu minör olan kafa travmalarýdýr. Bu hastalarda BT (bilgisayarlý tomografi) çekim ihtiyacýnýn belirlenmesine yardýmcý olmasý amacýyla son birkaç yýlda bazý klinik karar kurallarý yayýnlanmýþtýr. Bu çalýþmada iki yaþýndan küçük minör kafa travmalý çocuklarda BT çekim kararlarýnda PECARN (Pediatric Emergency Care Applied Research Network) kurallarýna uyum araþtýrýldý.
GEREÇ VE YÖNTEM: Bu geriye dönük, tek merkezli çalýþma iki yaþýndan küçük, travma oluþumunu takip eden ilk 24 saat içinde acil servise ilk baþvurusunu yapan ve baþvuru Glaskow Koma Skala skorlarý 14 ve 15 olan hafif kafa travmalý hasta grubunda yürütüldü.
BULGULAR: Çalýþmaya toplam 262 hasta dahil edildi. Bu hastalarýn 214’üne (%81.7) BT incelemesi yapýldýðý, 48’ine (%18.3) yapýlmadýðý saptandý. BT taramasý yapýlmayan 48 hastanýn hiçbirinde klinik olarak önemli travmatik beyin hasarý geliþmediði belirlendi. BT incelemesi yapýlan 214 hastadan 89’unda (%34) BT çekim kararý verilirken PECARN kurallarýna uyulduðu, 125 (%47.7) hastada bu kurallarýna uyulmadýðý saptandý. PECARN kriterlerini karþýlamayan ve BT incelemesi yapýlan hastalarýn hiçbirinde klinik olarak önemli travmatik beyin hasarý geliþmediði, PECARN kriterlerini karþýlayan 89 hastanýn sadece dördünde (%1.5) klinik olarak önemli travmatik beyin hasarý geliþtiði saptandý. Bu sonuçlara göre, kurumumuzda PECARN kurallarýna uyum oraný %52.3 idi.
TARTIÞMA: PECARN kýlavuzunun tüm belirleyici kriterleri dahil edilerek yürütülen çalýþmamýzda PECARN kurallarýna uyum oranýnýn düþük olduðu saptanmýþtýr. Gereksiz BT çekim oranlarýnýn düþürülmesi için klinisyenlerin bu kurallarý direkt veya modifiye ederek kullanmasý iyi bir baþlangýç noktasý oluþturabilir. Fakat klinisyen deneyimi, ebeveyn beklentisi, medikolegal çekinceler ve ekonomik faktörlerin bu karar üzerindeki etkisi unutulmamalýdýr.

BACKGROUND: One of the most common complaints about presentation at the Emergency Department (ED) in childhood is minor head trauma. In recent years, clinical decision rules (CDRs) have been published to assist in determining the need for performing computed tomography (CT) in these patients. The present study aims to investigate the compliance with Pediatric Emergency Care Applied Research Network (PECARN) rules in the decisions for CT examination in children aged below two years old with minor head trauma in our center.
METHODS: This retrospective, single-center study was conducted on a patient group aged below two years old, who presented at the ED within 24 hours of a trauma incident and were diagnosed as mild head trauma Glasgow Coma Scale score 14 and 15).
RESULTS: A total of 262 patients were included in this study. Of these patients, 214 (81.7%) received CT examination, and 48 (18.3%) patients did not receive any CT examination. None of these 48 patients showed clinically important traumatic brain injury (ci TBI). Among 214 patients who received CT examination, 89 (34%) patients met the PECARN rules criteria and 125 (47.7%) patients did not meet PECARN rules criteria. None of the patients who received CT examination and did not meet the PECARN rules criteria showed ci TBI. Among 89 patients who recieved a CT examination and also met the PECARN rules criteria, only 4 (1.5%) patients showed ci TBI. According to these results, the rate of compliance with PECARN rules in our institution ED was 52.3%.
CONCLUSION: In this study, which was conducted by including all the predictor values of the PECARN guidelines, the rate of compliance with PECARN rules was determined to be very low. Using these rules directly or with modification could establish a starting point for clinicians to reduce the rates of unnecessary CT scans. However, the effects of the clinician’s experience, parental expectations, medicolegal constraints and economic factors on the decision making process should not be forgotten.

AMAÇ: Penetran torasik travmasý sonrasýnda görülebilen diyafragma yaralanmalarýnýn tanýsýnda bazý zorluklar yaþanabilmektedir. Taný konulamamýþ küçük diyafragma yaralanmalarý, sonraki dönemde ciddi saðlýk sorunlarýna yol açabilirler. Bu çalýþmanýn amacý, penetran toraks travmasý sonrasýnda görülebilen diyafragma yaralanmalarýnýn taný ve tedavisinde VATS’nin (Video Yardýmlý Torakoskopik Operasyonlar) rolünü deðerlendirmektir.
GEREÇ VE YÖNTEM: Bu çalýþmada, 268 penetran toraks travmalý hasta arasýndan, Haziran 2008 ile Haziran 2018 tarihleri arasýnda bölümümüzde diyafragma yaralanmasý þüphesi ile VATS uygulanan toplam 22 hasta geriye dönük olarak deðerlendirildi.
BULGULAR: Yirmi (%91) hasta erkek, iki hasta (%9) kadýn olup, yaþ ortalamalarý 28.01±6.4 (18–42) yýldý. Penetran travmanýn yerine göre 11 (%50) hastada sað taraftan, diðerlerine sol taraftan VATS yapýldý. On (%45) hastada diyafragma laserasyonu tespit edildi ve tamir edildi. VATS ile diyafragma laserasyonunun saptanan altý olguda (%27) radyolojik olarak ek travmatik patolojiler saptandý. Radyolojik olarak yaralanmanýn atlanma oraný %18’di. VATS’ýn özgüllüðü, duyarlýlýðý, pozitif prediktif deðeri ve negatif prediktif deðerini sýrasýyla %75, %71.5, %60 ve %83.3 olarak hesaplandý. Penetran travma tipleri, yaþlarý ve cinsiyetleri arasýnda istatistiksel olarak anlamlý bir fark bulunamadý (p>0.05). 36.2±9.3 (9–62) ve aylýk ortalama takip süresince hiçbir komplikasyon görülmedi.
TARTIÞMA: Penetran toraks travma sonrasý þüpheli izole diyafragma laserasyonu düþünülen, radyolojik olarak belirlenemeyen hemodinamik olarak stabil hastalarda VATS’ýn önemli ve uygulanabilir olduðu görüþündeyiz.

BACKGROUND: Diaphragmatic injuries, which can be seen after penetrating thoracic traumas, have some difficulties in diagnosis. Undiagnosed small diaphragmatic lacerations may lead to serious health problems. This study aims to evaluate the role of VATS (Video Assisted Thoracoscopic Surgery) in the diagnosis and treatment of diaphragmatic injuries after penetrating thoracic traumas.
METHODS: Among 268 penetrating thoracic trauma patients, we retrospectively evaluated a total of 22 patients performed VATS due to suspected diaphragmatic injury in our department between June 2008 and June 2018.
RESULTS: Twenty (91%) patients were male, and two (9%) patients were female with a mean age of 28.01±6.4 (18–42) years. In 11 (50%) patients, VATS was performed on the right side and the others on the left side according to the penetrating area of trauma. In 10 (45%) patients, diaphragmatic laceration was detected and was repaired. In six cases (27%) in which diaphragmatic laceration detected with VATS, preoperative traumatic pathologies were detected radiologically. The missed injury rate was 18%. VATS had a specificity, sensitivity, positive predictive value and negative predictive value of 75%, 71.5%, 60% and 83.3%, respectively. There was no significant statistical difference between types of penetrating trauma, ages and gender of cases (p>0.05). No complication was detected during the mean follow up period of 36.2±9.3 (range 9–62) months.
CONCLUSION: Our opinion is that VATS is important and feasible in hemodynamically stable patients with suspected isolated diaphragmatic laceration after penetrating thoracic trauma that cannot be determined by radiologically.

Bu yazýda, pediatrik olgularda künt abdominal travma sonucu geliþen renal yaralanmalarýn tedavisinde transkateter embolizasyon kullanýmý ve sonuçlarý, bir olgu ve literatür eþliðinde deðerlendirildi. Abdominal künt travma sonrasý çocuklarda renal yaralanma gerçekleþmesi durumunda tedavi tercihi renal travmanýn derecesine ve hastanýn hemodinamisine baðlý olmakla birlikte, tedavide mümkün olduðunca non-operatif yöntemlerin kullanýlmasý önerilmektedir. Transkateter embolizasyon kullanýmý eriþkinlerde renal yaralanmalarda pratikte yaygýn olarak kullanýlýrken, çocuklarda kullanýmý ile ilgili deneyim azdýr. Yedi yaþýnda erkek hastada künt abdominal travma ve buna baðlý olarak geliþen grade IV renal yaralanma nedeniyle takibe alýndý. Konservatif yöntemlerle takip edilen hastada travma sonrasý 15. günde hematüri ve hemodinamide bozulma gerçekleþti. Renal anjiyografide; sað inferior segmental arterde psödoanevrizma ve arteriyovenöz fistül saptandý. Hastaya transkateter embolizasyon baþarýlý þekilde uygulandý, herhangi bir komplikasyon olmadýðý gibi renal hasarda görülmedi. Literatür deðerlendirmesinde pediatrik künt abdominal travma sonrasý renal yaralanama nedeniyle yapýlan transkateter embolizasyonun renal yaralanma derecesine bakýlmaksýzýn baþarý oraný %89.47’dir. Transkateter embolizasyon baþarýsýzlýðý nedeniyle dört hastada nefrektomi yapýlmýþ, hiçbir hastada uzun dönemde komplikasyon gözlenmemiþtir. Bu sonuçlar eþliðinde çocuklarda, künt abdominal travma sonrasý renal yaralanmalarýn transkateter embolizasyon ile tedavisinde; düþük komplikasyon ile yüksek baþarý bildirilmekte ve uzun dönemde renal fonksiyonun korunmasýnda da güvenilir bir yöntem olduðu anlaþýlmaktadýr.

This study aims to evaluate the clinical use and outcomes of transcatheter embolization in the setting of pediatric blunt renal trauma cases using an index case and review of the literature. Although the treatment method selection depends on the grade of the trauma and the hemodynamýc status of the patient, conservative methods are considered initially in the setting of pediatric blunt renal trauma. Transcatheter embolization, which is a relatively conservative treatment option, is commonly utilized in adult blunt renal trauma patient population; however, experience in the pediatric population is scarce. A seven-year-old male patient was admitted due to grade IV renal injury secondary to blunt abdominal trauma. He was conservatively followed until -on the post-trauma day 15- he developed gross hematuria and an unstable hemodynamic status. A renal angiogram was performed, which revealed right-sided renal inferior segmental artery pseudoaneurysm and arterio-venous fistula. Subsequently, a transcatheter embolization was performed. There were no complications and no permanent renal injury. Review of the literature revealed that the success rate of transcatheter embolization is 89.47% in the setting of pediatric blunt abdominal trauma-related renal injury regardless of the renal trauma grade. Four patients underwent nephrectomy due to a failed transcatheter embolization procedure. There are not any patients who suffered from embolization-related complications. These results suggest that transcatheter embolization can be safely performed in children with renal injuries due to blunt abdominal trauma with high success and low complication rates and preservation of renal function.

Tüplü dalýþ sýrasýnda dekompresyon nedeniyle ortaya çýkabilecek klinik belirtiler büyük ölçüde deðiþmekle birlikte esas olarak gastrointestinal sistemde sadece hafif semptomlar bildirilmiþtir. Özellikle, hava embolisinin neden olduðu iskemik kolit nadirdir. Biz baþarýsýz konservatif tedavi uygulanan ancak cerrahi olarak baþarýlý bir þekilde tedavi edilen tam kalýnlýkta iskemik kolit olgusunu sunuyoruz. Bildirdiðimiz hususlar tüplü dalýþtan sonra dekompresyonun gastrointestinal sistemde ciddi semptomlara neden olabileceðini ve cerrahi bir yaklaþým gerektirebileceðini düþündürmektedir. Tedavi semptomlarýn þiddetine ve hastanýn durumuna baðlý olmakla birlikte cerrahi yaklaþýmlar düþünülmelidir.

The clinical manifestations that may occur due to decompression during scuba diving vary widely, but only mild symptoms have been reported mainly in the gastrointestinal tract. In particular, ischemic colitis caused by air embolism is rare. We report a case of full-thickness ischemic colitis treated with failed conservative treatment but successfully treated surgically. The case that was presented here suggests that decompression after scuba diving may cause severe symptoms in the gastrointestinal tract and may require a surgical approach. Treatment depends on the severity of the symptoms and the patient’s condition, but surgical approaches should be considered.

Hayvanlarýn neden olduðu yaralanmalar, saldýran hayvanýn davranýþýna ve anatomisine dayanarak analiz edilmelidir. Ýnsanlarda gergedanla ilgili yaralanmalar son derece nadirdir. Bu vesileyle, bir gergedan tarafýndan göðsünden boynuz darbesi aldýktan üç yýl sonra baþvuran kadýn hastada yaþamý tehdit eden travmatik diyafragma hernisi olgusunu bildiriyoruz. Kýrk yedi yaþýnda kadýn hasta karýn aðrýsý, safralý kusma ve bir günlük obstipasyon ile baþvurdu. Önceden bir hafta boyunca tekrarlayan kolik tarzýnda karýn aðrýsý ataklarý geçirmiþti. Hastadan üç yýl önce hayvanat bahçesinde veteriner asistaný olarak çalýþýrken göðsüne bir gergedan tarafýndan boynuz darbesi aldýðýný ve yoðun bakým ünitesine kabul edildiði öðrenildi. Muayenede karýn þiþkin, yumuþak ve gevþekti. Baðýrsak sesleri abartýlýydý. Batýn grafileri çoklu hava sývý seviyeleri gösterdi. Röntgen çekimi sýrasýnda takip edilen gastrografin kontrast maddesi ince baðýrsakta takýlýp kaldý ve yedi saat sonra bile kolona ulaþmadý. Abdominal ve torasik bilgisayarlý tomografi taramasý, kolonun splenik fleksurasýnýn sol göðüste sol diyafragma fýtýðý içine yerleþmiþ olduðunu gösterdi. Acil laparotomide sol diyaframda 4 cm’lik postero-lateral defekt içine fýtýklaþan kolonun splenik fleksurasýnýn saðlýklý olduðu görüldü. Bu kolon segmenti redükte edildi ve defekt emilemeyen sütürlerle onarýldý. Ameliyat sonrasý iyileþme sorunsuzdu. Hasta ameliyattan 10 gün sonra taburcu edildi. Ýnsanlarda gergedanýn neden olduðu yaralanmalar son derece nadirdir. Yaþamý tehdit eden travmatik diyafragma hernisi birkaç yýl ertelenebilir. Tanýsý için þüphe indeksinin yüksek düzeyde olmasý gereklidir.

Animal-related injuries should be analyzed based on the behavior and anatomy of the attacking animal. Rhinoceros-related injuries in humans are extremely rare. Hereby, we report a life-threatening traumatic diaphragmatic hernia in a woman who presented three years after a rhinoceros gored her chest. A 47-year-old lady presented with abdominal pain, bilious vomiting and obstipation of one-day duration. She had recurrent attacks of colicky abdominal pain for a week before that. The patient gave the history of being admitted to the ICU three years before, after being gored by a rhinoceros into her chest while working as a veterinary assistant in the zoo. On examination, the abdomen was distended but soft and lax. Bowel sounds were exaggerated. Abdominal x-rays showed multiple air-fluid levels. A gastrographin follow through study hold up in the small bowel and did not reach the colon after seven hours. Abdominal and chest CT scan showed the splenic colonic flexure to be located in the left chest through a left diaphragmatic hernia. Urgent laparotomy showed a healthy splenic flexure of the colon that herniated through a 4 cm postero-lateral defect in the left diaphragm. The colon was reduced, and the defect was repaired with non-absorbable sutures. Postoperative recovery was smooth. The patient was discharged home 10 days after the surgery. Rhinoceros-related injuries in humans are extremely rare. Life-threatening traumatic diaphragmatic herniation may be delayed for few years. High index of suspicion is needed for its diagnosis.

Gezici dalak nadir görülen bir durumdur ve torsiyon veya enfarktüs gibi hayatý tehdit eden komplikasyonlara sebep olabilir. Semptomsuz olabilir, kronik abdominal aðrý veya intraabdominal kitle ile prezente olabilir. Klinik tanýsý genellikle zor olduðu için, radyolojik incelemeler tanýda çok önemli bir rol oynamaktadýr. Otuz yedi yaþýnda multipar kadýn karýn aðrýsý þikayeti ile acil servise baþvurdu. Hastanýn öyküsünden dokuz yýl önce gastrik volvulus nedeniyle ameliyat geçirdiðini öðrenildi. Ameliyat öncesi taný ultrasonografi ve bilgisayarlý tomografi ile yapýldý. Ýrreversibl infarkt nedeniyle splenektomi yapýldý. Gezici dalak torsiyonu, akut karýna neden olabilen nadir bir klinik durumdur. Bilgisayarlý tomografi ameliyat öncesi taný için altýn standarttýr. Gastrik volvulus ve gezici dalak benzer etiyolojilere sahiptir. Literatürde, bu iki hastalýðýn yetiþkinlikte birlikteliði nadiren bildirilmiþtir. Bununla birlikte, bildiðimiz kadarýyla, bu olgu, yetiþkinlikte farklý zamanlarda bu iki patolojinin ortaya çýkýþýný bildiren ilk çalýþmadýr.

Wandering spleen is a rare condition and has life-threatening complications, such as torsion or infarction. It may be asymptomatic or may present with chronic abdominal pain or intraabdominal mass. Since clinical diagnosis is usually difficult, radiological examinations play a very important role in diagnosis. A 37-year-old multiparous woman was admitted to the emergency room with a complaint of abdominal pain. The patient stated that she underwent an operation due to gastric volvulus nine years ago. Preoperative diagnosis was made by ultrasonography and computed tomography. Splenectomy was performed because of the irreversible infarction. Wandering spleen torsion is a rare clinical condition that may cause an acute abdomen. Computerized tomography is the gold standard for preoperative diagnosis. Gastric volvulus and wandering spleen have similar etiologies. In the literature, the coexistence of these two diseases in adulthood is rarely reported. However, to our knowledge, this case is the first report to describe the emergence of these two pathologies at different times in adulthood.

Künt karýn travmalarýna baðlý intraabdominal vasküler yaralanmalara ender rastlanmaktadýr. Süperiyor mezenterik ven (SMV) ve portal ven yaralanmalarýnýn acil þartlarda görüntülenmesi oldukça zordur. Bu yazýda, düþük hýzlý araç içi trafik kazasýnda direksiyon simidine çarpma ile oluþan künt batýn travmasý sonucu izole SMV yaralanmasý olan hasta ve tedavi yaklaþýmýmýz sunuldu. Altmýþ iki yaþ erkek hasta acil servise giriþini takiben yapýlan muayenesinde karýnda minimal distansiyon ve yaygýn hassasiyet olduðu görüldü. Ultrasonografisinde, karýn içerisinde yaygýn mayi varlýðý ve þüpheli karaciðer yaralanmasý bildirildi. Abdominal tomografide perihepatik ve perisplenik alanlarda sývý varlýðý saptandý. Solid organ yaralanmasýnýn olmadýðý görüldü. Laparatomide ince baðýrsak mezenterinde yaralanma görüldü. SMV üzerinde splenik ven birleþimi altýnda defekti mevcuttu. Uç yan damar anastomozu ve primer onarým gerçekleþtirildi. Altý ay süreyle yapýlan takiplerinde hastanýn aktif þikâyeti olmadýðý, yapýlan tetkikler sonucunda SMV ve portal ven de patoloji olmadýðý görüldü. Hemodinamik açýdan stabil olan süperior mezenterik venöz yaralanmalarýnda tecrübeli cerrahlarca uygulanan vasküler onarým tekniklerinin kullanýlmasýnýn anatomik ve fonksiyonel bütünlüðün devamlýlýðý açýsýndan önemli olduðunu düþünmekteyiz.

Intraabdominal vascular injuries due to blunt abdominal trauma are rare. It is very difficult to visualize superior mesenteric vein (SMV) and portal vein injuries under emergency conditions. In this case study, we reported a low-speed car accident, a patient with isolated SMV injury as a result of a blunt abdominal trauma that arose from a collision with a steering wheel. A 62-year-old male patient was admitted to the emergency department with minimal distention and diffuse tenderness in the abdomen. The presence of diffuse fluid in the abdomen and suspected liver injury were reported in ultrasonography. The presence of fluid in perihepatic and perisplenic areas was detected in abdominal tomography. No solid organ injury was observed. Laparotomy revealed an injury in the small intestine mesentery. There was a defect on SMV under splenic vein combination. End side vein anastomosis and primary repair were performed. During six months follow-up, the patient did not have active complaints, and there was no pathology in the SMV and portal vein. We think that the use of vascular repair techniques applied by experienced surgeons in hemodynamically stable superior mesenteric venous injuries is important concerning continuity of anatomical and functional integrity.